An analysis of outcomes of reconstruction or amputation after leg-threatening injuries.

Abstract

BACKGROUND:

Limb salvage for severe trauma has replaced amputation as the primary treatment in many trauma centers. However, long-term outcomes after limb reconstruction or amputation have not been fully evaluated.

METHODS:

We performed a multicenter, prospective, observational study to determine the functional outcomes of 569 patients with severe leg injuries resulting in reconstruction or amputation. The principal outcome measure was the Sickness Impact Profile, a multidimensional measure of self-reported health status (scores range from 0 to 100; scores for the general population average 2 to 3, and scores greater than 10 represent severe disability). Secondary outcomes included limb status and the presence or absence of major complications resulting in rehospitalization.

RESULTS:

At two years, there was no significant difference in scores for the Sickness Impact Profile between the amputation and reconstruction groups (12.6 vs. 11.8, P=0.53). After adjustment for the characteristics of the patients and their injuries, patients who underwent amputation had functional outcomes that were similar to those of patients who underwent reconstruction. Predictors of a poorer score for the Sickness Impact Profile included rehospitalization for a major complication, a low educational level, nonwhite race, poverty, lack of private health insurance, poor social-support network, low self-efficacy (the patient's confidence in being able to resume life activities), smoking, and involvement in disability-compensation litigation. Patients who underwent reconstruction were more likely to be rehospitalized than those who underwent amputation (47.6 percent vs. 33.9 percent, P=0.002). Similar proportions of patients who underwent amputation and patients who underwent reconstruction had returned to work by two years (53.0 percent and 49.4 percent, respectively).

CONCLUSIONS:

Patients with limbs at high risk for amputation can be advised that reconstruction typically results in two-year outcomes equivalent to those of amputation.

• Authors: Michael J Bosse, Ellen J MacKenzie, James F Kellam, Andrew R Burgess, Lawrence X Webb, Marc F Swiontkowski, Roy W Sanders, Alan L Jones, Mark P McAndrew, Brendan M Patterson, Melissa L McCarthy, Thomas G Travison, Renan C Castillo
• Journal: The New England journal of medicine (N Engl J Med) Vol. 347 Issue 24 Pg. 1924-31 (Dec 12 2002) ISSN: 1533-4406 [Electronic] United States
• PMID: 12477942 (Publication Type: Comparative Study, Evaluation Study, Journal Article, Research Support, U.S. Gov't, P.H.S.)
• Copyright: Copyright 2002 Massachusetts Medical Society

Topics

• Activities of Daily Living
• Adult
• Amputation, Surgical
• Female
• Hospitalization
• Humans
• Leg Injuries (classification, rehabilitation, surgery)
• Limb Salvage
• Male
• Medically Uninsured
• Multivariate Analysis
• Outcome Assessment, Health Care
• Postoperative Complications
• Prospective Studies
• Recovery of Function
• Regression Analysis
• Sickness Impact Profile
• Social Support
• Socioeconomic Factors